Mediating effect of sleep quality on the relationships between psychological distress, social media addiction, gaming disordser and night eating syndrome among Malaysian university students

Night Eating Syndrome (NES) is an atypical eating disorder characterized by frequent nighttime awakenings requiring food intake to return to sleep. Recently, this problematic eating behavior has gained increasing attention and has become a global concern within the research community. Research on NES has been predominantly conducted in Western societies, leaving a gap in understanding its prevalence and associated factors in Malaysia. The COVID-19 endemic has exacerbated issues such as a rising trend in poor sleep quality, increased risk of psychological distress, increased engagement in social media addiction and gaming disorder, contributing to a growing public health concern. Given the significance of these issues, extensive research is warranted, particularly to understand their complex relationships with NES. Therefore, this cross-sectional study aimed to determine the role of sleep quality as a mediator in the relationships between psychological distress, social media addiction, gaming disorder and NES among Malaysian university students. A total of 693 university students were recruited in this study using convenience sampling method from 1 May to 31 December 2022. An online survey using Google Form was distributed through social media platforms (Facebook, WhatsApp and Instagram). Participants completed an online survey included information on sociodemographic background, Night Eating Syndrome Questionnaire (NEQ), Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale (DASS-21), Bergen Social Media Addiction Scale (BSMAS) and Gaming Disorder Test (GDT). Participants with a NEQ score of >25 were classified as having NES, whereas those with a PSQI score above 5 were identified as having poor sleep quality. In terms of mild to severe depression, anxiety, and stress, the threshold was defined as >9 for depression, >7 for anxiety, and >14 for stress. Moreover, scoring over 19 on the BSMAS indicated a high likelihood of social media addiction and as for gaming disorder, if they answered "often" (4) or "very often" (5) to all four questions in the GDT, they had risk of gaming disorder. The Partial Least Square Structural Equation Modelling (PLS-SEM) using the SmartPLS 3.0 software was used to test the mediation analysis in this study. The results showed that the prevalence of NES was 8.7%, with a mean score of 18.96±5.16, ranging from 0 to 52. Psychological distress (β=0.156, p<0.001), social media addiction (β=0.074, p=0.048) and gaming disorder (β=0.158, p<0.001) were found to be related significantly to NES. Psychological distress (β=0.420, p<0.001) and social media addiction (β=0.112, p=0.002) were also significantly related to sleep quality, while sleep quality was significantly related to NES (β=0.274, p<0.001). No relationship was found between gaming disorder and sleep quality (β=0.032, p=0.418). Based on the mediation analysis, the results showed that sleep quality mediated the relationships between psychological distress and NES (β=0.115, p<0.001) as well as social media addiction and NES (β=0.031, p=0.005). However, sleep quality did not mediate the relationship between gaming disorder and NES (p=0.426). In conclusion, this study provided insights that sleep quality mediated the relationships between psychological distress, social media addiction and NES among Malaysian university students. In other words, university students with psychological distress and social media addiction tend to have poor sleep quality, which in turn has the potential to lead to NES. Findings of this study highlighted the importance of early intervention for students experiencing NES, specifically those struggling with psychological distress and social media addiction, with a particular focus on those with sleep problems. Future studies should examine these relationships in a longitudinal manner and use the information gathered to inform the development of interventions.

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